Last update: Feb. 12, 2019

Maternal Candidiasis

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Among the many existing Candida species, the one that most frequently affects humans is Candida albicans, which is a commensal frequently found in the mouth, gastrointestinal tract, vagina and skin and only occasionally causes disease.
It can be found in the nipple/areola of more than a third of healthy, asymptomatic mothers (Boix 2017, Hanna 2011, Francis 2004) and some associate it with the early use of feeding bottles (Morrill 2005).

Oligosaccharides, lysozyme and dermcidin in breastmilk inhibit the growth and adhesion of candida, protecting the intestine of the infant, especially premature infants (Chow 2016, Gonia 2015, Vudhichamnong 1982).

The deep, burning pain of the breast and nipple during breastfeeding has been classically associated but without laboratory tests, - culture, PCR (Hanna 2011, Moorhead 2011, Hoover 1999, Bodley 1997), with ductal infection or candida mastitis (Lawrence 2016 p 468, ABM 2014, Brent 2001), this association being questioned (ABM 2014, Carmichael 2002) since when milk samples are taken from women with this type of pain, the cultures can be negative, or candida can also grow on the breasts of healthy women, or Staphylococcus aureus can also appear (Witt 2014, Amir 2013, Betzold 2012, Hale 2009, Eglas 2006, Graves 2003, Thomassen 1998).

It should also rule out other possible diagnoses as bad latching, vasospasm or Raynaud’s phenomenon of the nipple, dermatosis of the nipple, depressive symptoms, functional pain or milk overproduction (Berens 2016).

Candida was found in a small proportion of cases of deep pain, but also in asymptomatic women (Amir 2013, Betzold 2012).
Candida was found in 25% of women with deep breast pain, but there were no significant differences in symptoms and evolution depending on the positivity or negativity of the culture (Kaski 2018).
One study found no significant differences in the proportion of candida found (by culture or CRP) in healthy women and in women with symptoms of deep breast pain (Mutschlechner 2016), while others did: 54% in cases of pain, compared with 36% in women without pain (Amir 2013) or 30% versus 8% respectively (Andrews 2007).

The diagnosis of internal or ductal candidiasis, or candida mastitis is therefore controversial, but there may be infection of the nipple/areola, or oral, cutaneous or vaginal infection in the mother.

Given that the mother and the infant can infect each other, both should be treated (Barrett 2013), without forgetting the mother's partner.

Neither the maternal disease nor the required treatments are incompatible with breastfeeding (Kaplan 2015).


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Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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References

  1. Kaski K, Kvist LJ. Deep breast pain during lactation: a case-control study in Sweden investigating the role of Candida albicans. Int Breastfeed J. 2018 Abstract
  2. Boix-Amorós A, Martinez-Costa C, Querol A, Collado MC, Mira A. Multiple Approaches Detect the Presence of Fungi in Human Breastmilk Samples from Healthy Mothers. Sci Rep. 2017 Abstract
  3. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  4. Berens P, Eglash A, Malloy M, Steube AM. ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeed Med. 2016 Abstract
  5. Chow BD, Reardon JL, Perry EO, Laforce-Nesbitt SS, Tucker R, Bliss JM. Host Defense Proteins in Breast Milk and Neonatal Yeast Colonization. J Hum Lact. 2016 Abstract
  6. Mutschlechner W, Karall D, Hartmann C, Streiter B, Baumgartner-Sigl S, Orth-Höller D, Lass-Flörl C. Mammary candidiasis: molecular-based detection of Candida species in human milk samples. Eur J Clin Microbiol Infect Dis. 2016 Abstract
  7. Kaplan YC, Koren G, Ito S, Bozzo P. Fluconazole use during breastfeeding. Can Fam Physician. 2015 Abstract
  8. Gonia S, Tuepker M, Heisel T, Autran C, Bode L, Gale CA. Human Milk Oligosaccharides Inhibit Candida albicans Invasion of Human Premature Intestinal Epithelial Cells. J Nutr. 2015 Abstract
  9. Witt AM, Burgess K, Hawn TR, Zyzanski S. Role of oral antibiotics in treatment of breastfeeding women with chronic breast pain who fail conservative therapy. Breastfeed Med. 2014 Abstract
  10. Amir LH; Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeed Med. 2014;9(5):239-243. Abstract Full text (link to original source) Full text (in our servers)
  11. Amir LH. y el Comité de protocolos de la Academy of Breastfeeding Medicine. Protocolo clínico de la ABM n.o 4: Mastitis, modi cado en marzo de 2014. Breastfeed Med. 2014;9(5):239-243. Abstract Full text (link to original source) Full text (in our servers)
  12. Barrett ME, Heller MM, Fullerton Stone H, Murase JE. Dermatoses of the breast in lactation. Dermatol Ther. 2013 Abstract
  13. Amir LH, Donath SM, Garland SM, Tabrizi SN, Bennett CM, Cullinane M, Payne MS. Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia. BMJ Open. 2013 Abstract
  14. Betzold CM. Results of microbial testing exploring the etiology of deep breast pain during lactation: a systematic review and meta-analysis of nonrandomized trials. J Midwifery Womens Health. 2012 Abstract
  15. Hanna L, Cruz SA. Candida mastitis: a case report. Perm J. 2011 Abstract Full text (link to original source) Full text (in our servers)
  16. Moorhead AM, Amir LH, O'Brien PW, Wong S. A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeed Rev. 2011 Abstract
  17. Hale TW, Bateman TL, Finkelman MA, Berens PD. The absence of Candida albicans in milk samples of women with clinical symptoms of ductal candidiasis. Breastfeed Med. 2009 Abstract
  18. Andrews JI, Fleener DK, Messer SA, Hansen WF, Pfaller MA, Diekema DJ. The yeast connection: is Candida linked to breastfeeding associated pain? Am J Obstet Gynecol. 2007 Abstract
  19. Morrill JF, Heinig MJ, Pappagianis D, Dewey KG. Risk factors for mammary candidosis among lactating women. J Obstet Gynecol Neonatal Nurs. 2005 Abstract
  20. Francis-Morrill J, Heinig MJ, Pappagianis D, Dewey KG. Diagnostic value of signs and symptoms of mammary candidosis among lactating women. J Hum Lact. 2004 Abstract
  21. Carmichael AR, Dixon JM. Is lactation mastitis and shooting breast pain experienced by women during lactation caused by Candida albicans? Breast. 2002 Abstract
  22. Brent NB. Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment. Clin Pediatr (Phila). 2001 Abstract
  23. Hoover K. Breast pain during lactation that resolved with fluconazole: two case studies. J Hum Lact. 1999 Abstract
  24. Bodley V, Powers D. Long-term treatment of a breastfeeding mother with fluconazole-resolved nipple pain caused by yeast: a case study. J Hum Lact. 1997 Abstract
  25. Vudhichamnong K, Walker DM, Ryley HC. The effect of secretory immunoglobulin A on the in-vitro adherence of the yeast Candida albicans to human oral epithelial cells. Arch Oral Biol. 1982 Abstract

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